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Health Care Appraisal Form Michigan
And Recommended Caloric Intake 16. Other Health-Related Information or Concerns M. Susceptibility to Hyper / Hypothermia and Related Limitations Deferred as used here means examination considered but postponed Explanation of Abnormalities/Treatment Ordered 14. D. /D. O. /P. A. or R.N. Please Print Name Signature Address AUTHORITY 1979 PA 218 COMPLETION Required. CONSEQUENCE Violation of AFC Licensing Rules. Signature of Resident / Legal Guardian Title Date Release of HIV/AIDS Information By...
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